Surgical and Transcatheter Closure of Right Pulmonary Artery to Left Atrial Fistula

Li, Guohua; Ma, Wei-Guo; Huang, Lianjun; Yan, Jun; Zhu, Xiaoyan

doi:10.1111/j.1540-8191.2010.01204.x

Cited by 13 publications

(22 citation statements)

References 26 publications

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“…The long-term prognosis of patients with RPA-LA communication is favorable [7]. Late detection of the fistula and hypoplasia of the peripheral pulmonary arteries are potential risk factors for an adverse outcome.…”

Section: Discussionmentioning

confidence: 99%

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Burkamp

Ghisla²,

Knirsch

et al. 2012

Pediatr Cardiol

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Right pulmonary artery-to-left atrial communication is a rare congenital vascular malformation that results in a right-to-left shunting. This report describes the case history of a neonate with a large right pulmonary artery-to-left atrial connection resulting in cyanosis and severe heart failure who underwent successful early catheter interventional therapy. In the neonate, this lesion can be diagnosed accurately using transthoracic echocardiography. Closure of the communication can be achieved even in infants via percutaneous interventional catheterization with a low procedure-related risk and a good midterm follow-up result.Keywords Catheter interventional therapy Á Congenital heart defect Á Pulmonary artery-to-left atrium communication Á Neonate One-third of neonatal cyanosis cases are caused by congenital heart defects and it is important to differentiate them from pulmonary disease or persistent fetal circulation [5]. Right pulmonary artery (RPA)-to-left atrium (LA) communication involves a direct connection between the pulmonary artery and the pulmonary vein or LA [11] and is a very uncommon cause of right-to-left shunting. This pathologic vascular communication results in a large shunting of venous blood to the arterial side, leading to both cyanosis and volume overload. Case ReportA female term neonate with a birth weight of 3 kg and 620 g presented 14 h postnatally with central cyanosis and clinical signs of respiratory distress. An echocardiogram showed a large RPA-LA communication from the proximal RPA to the roof of the LA (Fig. 1). The LA and the left ventricle were dilated, and left ventricular function was impaired (ejection fraction, 33%).The patient's condition improved and stabilized after initiation of continuous epinephrine and milrinone administered intravenously. After 6 days, cardiac catheterization was performed with the patient under general anesthesia via a transfemoral venous approach using a 5-Fr introducer sheath. The size and anatomy of the fistula were identified and measured by a selective pulmonary angiogram (Fig. 2).Due to the shunt volume, the diameter of the proximal RPA was double that of the left pulmonary artery. The fistula itself measured 9-mm at the pulmonary end, narrowed to 2.2-mm, and widened again to 9-mm at the atrial end at the roof of the LA.The communication was entered from the pulmonary arterial side with an 0.018 in. wire. Through the 5-Fr sheath and across the wire, a flexible introducer catheter was advanced into the fistula. Successful closure then was performed with a detachable patent arterial duct (PDA) coil (7 9 6-mm, Nit-Occlud; pfm, Cologne, Germany) from the pulmonary arterial side. Three loops of the coil were placed into the LA, and the remaining loops were placed into the fistula and the RPA.After confirmation that the positioning of the device was stable and the flow of the RPA and LA was unimpaired (via a contrast injection through the introducer catheter and a transthoracic echocardiography), the coil was released. A final angiogram s...

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Section: Discussionmentioning

confidence: 99%

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Burkamp

Ghisla²,

Knirsch

et al. 2012

Pediatr Cardiol

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“…Of these cases only 23 were diagnosed in adults [1]. Cyanotic congenital heart disease is rarely diagnosed in adults, but carries a five-year mortality of 12.6% [4].…”

Section: Discussionmentioning

confidence: 99%

“…We report a case of splenic infarct caused by a direct communication between the right pulmonary artery and the left atrium. To date only 23 cases of such a lesion exist in the literature in adult patients [1].…”

Section: Introductionmentioning

confidence: 99%

“…The splenic infarct was caused by an emboli from the right side of the circulation that traveled across a communication between the right pulmonary artery and the left atrium. This lesion has only been cited in 23 adult cases [1]. When the communication was identified on transthoracic echocardiogram, she was diagnosed with cyanotic congenital heart disease and the etiology for her clubbing was discovered.…”

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confidence: 99%

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A Case of Abdominal Pain, Hypoxia and Clubbing

Stojan

2013

J Med Cases

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Cyanotic congenital heart disease is often diagnosed in infancy.Here we present a case of a 19-year-old female who presented with abdominal pain, hypoxia and clubbing. She was found to have a splenic infarct on CT scan. The splenic infarct was caused by an emboli from the right side of the circulation that traveled across a communication between the right pulmonary artery and the left atrium. This lesion has only been cited in 23 adult cases [1]. When the communication was identified on transthoracic echocardiogram, she was diagnosed with cyanotic congenital heart disease and the etiology for her clubbing was discovered.

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“…An Amplatzer septal occluder (AGA Medical, Plymouth, MN, USA) was loaded and was delivered through the previously placed delivery sheath under fluoroscopic guidance. Once the position and stability of the Amplatzer septal occluder were confirmed, it was released by counterclockwise rotation of the vise attached to the delivery cable …”

Section: Surgical and Percutaneous Interventionsmentioning

confidence: 99%

Transthoracic Echocardiography for Diagnosis of Right Pulmonary Artery to Left Atrial Fistula

Lǐ

Wang

et al. 2012

Echocardiography

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Right pulmonary artery to left atrial fistula (RPA-LAF) is a rare cardiovascular anomaly. There were no systematic and detail represent by echocardiography. We chose the patients who diagnosed with RPA-LAF at Fuwai Hospital from 2000 to 2010. All patients underwent clinical examination, chest roentgenogram, laboratory testing, electrocardiography, transthoracic echocardiography (TTE), contrast echocardiography, and cardiac catheterization. In this article, we summarize the characteristics of the TTE for diagnosing the rare cardiovascular anomaly of RPA-LAF. We undertook a detailed review of their TTE and contrast echocardiography findings to determine the characteristic findings of this condition.

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Surgical and Transcatheter Closure of Right Pulmonary Artery to Left Atrial Fistula

Abstract: Both surgical and transcatheter closure are safe and reliable treatment for patients with right pulmonary artery to left atrial fistula. The treatment should be individualized and performed as soon as the diagnosis is made.

Cited by 13 publications

References 26 publications

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

Catheter Interventional Closure of a Large Right Pulmonary Artery–to–Left Atrial Communication in a Neonate

A Case of Abdominal Pain, Hypoxia and Clubbing

Transthoracic Echocardiography for Diagnosis of Right Pulmonary Artery to Left Atrial Fistula

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